11 Gross Things That Could Be On Your Toothbrush

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Before you brush today, consider this: Poop is just the beginning of what could possibly be hanging out on your toothbrush.

1. E. COLI

Guess what? If your bathroom has the sink and toilet in one room, and you flush with the lid open, there is fecal matter on everything within a 5 to 6 foot radius. Flushing aerosolizes your poop, depositing bacteria like Escherichia coli, or E. coli, directly onto your toothbrush—and brushing with an E. coli-loaded instrument could make you sick. “This bacteria is associated with gastrointestinal disease,” says Dr. Maria Geisinger, DDS, an assistant professor and periodontist at the University of Alabama at Birmingham.

Gastroenteritis, or infectious diarrhea, is one such illness. “In bathrooms with a toilet attached, [researchers] looked at toothbrushes in normal use between one and three months,” Geisinger says. “At the three-month mark, they found E. coli colonies. That’s a good reminder to replace your toothbrush every three months.”

Once E. coli and the other bacteria on this list form colonies, they’re a lot harder to kill because “they start to make an extracellular matrix, which protects them from antimicrobial medicines that you might use in the toothpaste, mouthwash, and even antibiotics,” Geisinger says. “One of the reasons you can’t just take an antibiotic and say ‘oh good, my dental disease is cured’ is because they’re actually in a biofilm.”

The colonies on your toothbrush are similar to the algae that grows at the bottom of the pool, according to Geisinger. “Your pool is full of water—you can’t just swish it around and get that algae off,” Geisinger says. “It’s got to be scrubbed off because it’s protected by this extracellular matrix. In fact, complex biofilms have a circulatory system. So they’re almost like a living organism, composed of all this different bacteria.”

So make sure to flush with the lid down, which will greatly decrease aerosolization, and, therefore, the literal crap on your toothbrush. Also, be sure to wash your hands after you use the restroom and before you brush to avoid transferring fecal matter to your toothbrush that way, Geisinger says, and change your toothbrush every three months.

2. STAPHYLOCOCCUS AUREUS

This bacteria typically lives in your respiratory tract and on your skin, and, under the right conditions, can be responsible for some pretty nasty stuff. “It’s often associated with [antibiotic resistant] MRSA infections or necrotizing fasciitis, which is flesh-eating bacteria,” Geisinger says. Necrotizing fasciitis occurs when bacteria enters the skin through an open wound, and, according to the CDC, most often affects people who have other health problems that might hinder their bodies’ efforts to fight infection. Thankfully, this condition very rare, but you still don’t want the stuff that could cause it on your toothbrush.

3. STREPTOCOCCUS MUTANS

It makes sense that this bacteria would be on your toothbrush—it’s responsible for tooth decay. “But again, we’d like it not to be there,” Geisinger says. “You don’t want to take tooth decaying material from one area of your mouth and put it in another while you’re trying to do your due-diligence about removing deposits.”

Keeping bacteria and other nasty stuff to a minimum on your toothbrush could be as simple as what you buy. According to one study, “Toothbrushes with lighter or clear bristles retain up to 50 percent less bacteria than colored toothbrush bristles,” Geisinger says, potentially because clear toothbrush bristles have less porosity than colored ones. And instead of brushes with fancy perforated or rubber handles, opt for solid plastic handles which studies have shown “had less microbio load than larger or perforated or multi-surface handles [because there are] fewer nooks and crannies for the bacteria to hide in,” Geisinger says.

4. FOOD DEBRIS

That thing you had for dinner last night? Yeah, it’s probably still on your toothbrush the next morning … and now it’s food for the bacteria on there, too! (As are your poop particles. Yuck.) Avoid having unintentional leftovers and clear out bacteria by washing your brush before it goes in your mouth in potable tap water or antibacterial mouth rinse, Geisinger says.

5. AND 6. LACTOBACILLUS and PSEUDOMONAS

“These are two bacteria that have been associated with pneumonia type infections, particularly in hospital settings” where a patient is on a ventilator, Geisinger says. Though Lactobacillus is typically considered a “friendly” bacteria—it’s sometimes used to treat diarrhea and is present in foods and our own guts—it can also be linked to cavities and tooth decay. Pseudomonas can cause eye infections if you use contacts and don't clean them adequately.

Bacteria thrives on brushes that have frayed bristles, by the way, so Geisginer (and the American Dental Association) recommend replacing your toothbrush if the bristles are looking like they’ve seen better days—even if you haven’t hit the three-month mark yet.

7. HERPES SIMPLEX TYPE ONE

And now, a virus! “Herpes simplex type one used to be called oral herpes, but now almost 50 percent of genital lesions are also herpes simplex type one,” Geisinger says. “The viruses are different than bacteria because they come in little capsules, and they’re not technically alive—they need your cells to replicate. In a patient who has an active herpes outbreak, an oral cold sore, that virus can be retained on the toothbrush up to a week.”

Geisinger says she's not aware of any research into "the viability of the viruses on the toothbrushes," but says that transfer of a virus from one person to another by sharing toothbrushes is a possibility under the right circumstances. "HSV can be transmitted in saliva, so sharing toothbrushes during an oral herpes outbreak could lead to a higher risk transfer of viral particles and therefore disease," she says.

8. HPV

Another virus that can make a home on your toothbrush is Human papillomavirus, or HPV. “It’s linked to both cervical cancer and esophageal and oral cancers,” Geisinger says. “The interesting thing about HPV is that the presence of HPV in your mouth seems to decrease if you do a good job with toothbrushing.” And once again, if you share toothbrushes with someone who has HPV, you could be at risk for contracting it yourself. "Both viruses are transmissible in saliva," Geisinger says, "so viral transmission through shared toothbrushes is a possibility."

9. CANDIDA

This fungus is responsible for yeast infections and diaper rash. The most common species in the mouth is called Candida albicans, which causes oral thrush—basically, a yeast infection in your mouth. “[C. albincans] is linked to higher decay rates in kids,” Geisinger says. “In kids that have candida infections, about 15 percent have candida reservoirs on their toothbrush, and it can certainly be passed among siblings or other toothbrushes stored in the same area.” To keep candida from infecting multiple toothbrushes, make sure that the instruments are stored upright and away from each other.

10. MOISTURE

According to Geisinger, one of the worst things you have on your toothbrush is moisture because it encourages bacteria to grow. “There’s a precipitous drop in bacteria [on toothbrushes] after about 24 hours, and that’s really because the toothbrush dries out," she says. "So, if you can, having two toothbrushes is probably advantageous.” If you’re using a toothbrush just once every 24 hours, it will stay nice and dry, and bacterial loads will be low.

Another thing you shouldn’t do: Cover your toothbrush. “Even though it’s tempting because of the fecal matter from the toilet, covering toothbrushes or putting them in your medicine cabinet does not allow them to dry out,” Geisinger says. “Bacterial counts on those toothbrushes are considerably higher than on toothbrushes that are stored upright, separate, and allowed to dry completely.”

11. BLOOD

Up to 70 percent of adults in the United States have gingivitis, and about 47 percent of people over the age of 30 have destructive gum disease. "That means they have ulcerations or microscopic breaks in the tissue underneath the gum lines where they can’t see, which allows blood to get on the toothbrush,” Geisinger says. “It also allows a pathway for bacteria to get into the bloodstream. In patients with inflammation, bacteria in your bloodstream spike after things that would irritate those inflammations—including mastication, eating, toothbrushing, even a visit to your dentist to have a cleaning.” That’s how dental and oral bacteria end up in plaques that are associated with heart disease.

“The amount of bacteria in the bloodstream is actually proportional to how much inflammation and dental disease is present in the mouth,” Geisinger says. “Patients who are receiving regular dental care—that includes dental cleaning and exams—have improved levels of gingival inflammation, less blood in their saliva, and less blood on their toothbrush. So go see your dentist!”

This piece originally ran in 2016.

10 Facts About Rosacea

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Rosacea, a skin condition characterized by redness and swelling, is incredibly common: A recent study found that an estimated 300 million people worldwide suffer from it. Here’s what you need to know about the condition.

1. IT HAS A LONG HISTORY.

According to the National Rosacea Society (NRS), rosacea was first described in the 14th century by a French surgeon named Dr. Guy de Chauliac; he called it goutterose (“pink drop” in French) or couperose and noted that it was characterized by “red lesions in the face, particularly on the nose and cheeks.”

2. SCIENTISTS AREN’T SURE WHAT CAUSES IT ...

But they have some theories. According to the NRS, “most experts believe it is a vascular disorder that seems to be related to flushing.” Scientists also think that because rosacea seems to run in families, it might be genetic. Other things—like mites that live on the skin, an intestinal bug called H pylori (common in those who have rosacea), and a reaction to a bacterium called bacillus oleronius—could also play a role in causing the condition. One 2015 study suggested an increased risk among smokers.

3. … BUT SOME PEOPLE ARE MORE LIKELY TO HAVE IT THAN OTHERS.

Though people of all ages and skin tones can get rosacea, fair skinned people between the ages of 30 and 50 with Celtic and Scandinavian ancestry and a family history of rosacea are more likely to develop the condition. Women are more likely to have rosacea than men, though their symptoms tend to be less severe than men’s. But men are more likely to suffer from a rare rosacea side effect known as rhinophyma, which causes the skin of the nose to thicken and become bulbous. It’s commonly—and mistakenly—associated with heavy drinking, but what exactly causes rhinophyma is unclear. According to the NRS, “The swelling that often follows a flushing reaction may, over time, lead to the growth of excess tissue (fibroplasia) around the nose as plasma proteins accumulate when the damaged lymphatic system fails to clear them. Leakage of a substance called blood coagulation factor XIII is also believed to be a potential cause of excess tissue.” Thankfully, those who have rhinophyma have options available for treatment, including surgery and laser therapy.

4. THERE ARE FOUR SUBTYPES.

According to the American Academy of Dermatology (AAD), rosacea “often begins with a tendency to blush or flush more easily than other people.” All rosacea involves redness of some kind (typically on the nose, cheeks, chin, and forehead), but other symptoms allow the condition to be divided into four subtypes: Erythematotelangiectatic rosacea is characterized by persistent redness and sometimes visible blood vessels; Papulopustular rosacea involves swelling and “acne-like breakouts”; Phymatous rosacea is characterized by thick and bumpy skin; and Ocular rosacea involves red eyes (that sometimes burn and itch, or feel like they have sand in them [PDF]), swollen eyelids, and stye-like growths.

5. IT’S NOT THE SAME AS ACNE.

Though rosacea was once considered a form of acne—"acne rosacea" first appeared in medical literature in 1814—today doctors know it’s a different condition altogether. Though there are similarities (like acne, some forms of rosacea are characterized by small, pus-filled bumps) there are key differences: Acne involves blackheads, typically occurs in the teen years, and can appear all over the body; rosacea is a chronic condition that occurs mainly on the face and the chest and typically shows up later in life.

6. YOU CAN FIND IT IN CLASSIC ART AND LITERATURE.

Both Chaucer and Shakespeare likely made references to rosacea. Domenico Ghirlandaio’s 1490 painting An Old Man and His Grandson seems to depict rhinophyma, and some believe that Rembrandt’s 1659 self-portrait shows that the artist had rosacea and rhinophyma.

7. IT MAY BE TRIGGERED BY CERTAIN FOODS AND ACTIVITIES.

According to the National Institutes of Health (NIH) [PDF], people report that everything from the weather to what you eat can cause rosacea to flare up: Heat, cold, sunlight, and wind, strenuous exercise, spicy food, alcohol consumption, menopause, stress, and use of steroids on the skin are all triggers.

8. THERE ARE A NUMBER OF MYTHS ABOUT ROSACEA.

No, it’s not caused by caffeine and coffee (flare ups, if they occur, are due to the heat of your coffee) or by heavy drinking (though alcohol does exacerbate the condition). Rosacea isn’t caused by poor hygiene, and it’s not contagious.

9. THERE ARE SOME PRETTY FAMOUS PEOPLE WITH ROSACEA.

Sophia Bush, Cynthia Nixon, Kristin Chenoweth, Bill Clinton, and Sam Smith all have rosacea. Diana, Princess of Wales had it, too. W.C. Fields had rosacea and rhinophyma, and Andy Warhol may also have suffered from those conditions.

10. IT CAN’T BE CURED—BUT IT CAN BE TREATED.

The NRS reports that “nearly 90 percent of rosacea patients [surveyed by NRS] said this condition had lowered their self-confidence and self-esteem, and 41 percent reported it had caused them to avoid public contact or cancel social engagements.” Dr. Uwe Gieler, a professor of dermatology at the Justus-Liebig-University in Giessen, Germany, and one of the authors of the report Rosacea: Beyond the Visible, said in a press release that "People with rosacea are often judged on their appearance, which impacts them greatly in daily life. If their rosacea is severe, the symptoms are likely to be more significant also, from itching and burning to a permanently red central facial area. However, even people with less severe rosacea report a significant impact on quality of life."

Which makes it all the more unfortunate that there’s not a cure for the condition. Thankfully, though, there are treatments available.

There are no tests that will diagnose rosacea; that’s up to your doctor, who will examine your medical history and go over your symptoms. Doctors advise that those with rosacea pay attention to what triggers flare-ups, which will help them figure out how to treat the condition. Antibiotics might be prescribed; laser therapy might be used. Anyone with rosacea should always wear sunscreen [PDF] and treat their skin very, very gently—don't scrub or exfoliate it. The AAD recommends moisturizing daily and avoiding products that contain things like urea, alcohol, and glycolic and lactic acids.

How Often Should You Poop?

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When it comes to No. 2, plenty of people aren’t really sure what’s normal. Are you supposed to go every day? What if you go 10 times a day? Is that a sign that you’re dying? What about once every three days? Short of asking everyone you know for their personal poop statistics, how do you know how often you’re supposed to hit the head?

Everyone’s system is a little different, and according to experts, regularity is more important than how often you do the deed. Though some lucky people might think of having a bowel movement as an integral part of their morning routine, most people don’t poop every day, as Lifehacker informs us. In fact, if you go anywhere between three times a day and three times a week, you’re within the normal range.

It’s when things change that you need to pay attention. If you typically go twice a day and you suddenly find yourself becoming a once-every-three-days person, something is wrong. The same thing goes if you normally go once every few days but suddenly start running to the toilet every day.

There are a number of factors that can influence how often you go, including your travel schedule, your medications, your exercise routine, your coffee habit, your stress levels, your hangover, and, of course, your diet. (You should be eating at least 25 to 30 grams of fiber a day, a goal that most Americans fall significantly short of.)

If you do experience a sudden change in how often you take a seat on the porcelain throne, you should probably see a doctor. It could be something serious, like celiac disease, cancer, or inflammatory bowel disease. Or perhaps you just need to eat a lot more kale. Only a doctor can tell you.

However, if you do have trouble going, please, don’t spend your whole day sitting on the toilet. It’s terrible for your butt. You shouldn’t spend more than 10 to 15 minutes on the toilet, as one expert told Men’s Health, or you’ll probably give yourself hemorrhoids.

But if you have a steady routine of pooping three times a day, by all means, keep doing what you’re doing. Just maybe get yourself a bidet.

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